The Relation Between Early Psychosocial Deprivation and Mental Health at 12 Years

描述（由申请人提供）：敏感期被定义为大脑以活动模式的形式对经历特别敏感的发育时期（Daw, 1997）。如果经历的存在或不存在导致不可逆转的变化，这个时间点可以被称为“关键”时期（Newport, Hindle, & Jackson, 2001; Trachtenberg & Stryker, 2001）。在少数领域（例如，视觉和知觉发展），那些使潜在发展的电路具有可塑性（或使其不可改变）的因素正变得越来越好。然而，关于婴儿和儿童正常社会和情感发展的敏感时期的数据缺乏，而且对早期发展过程中异常经历对精神病理出现的影响知之甚少。婴儿自出生起就被遗弃在机构的案例提供了一个机会来检查严重的社会心理剥夺和典型的神经、社会情感和认知发展的敏感时期的影响，以及导致精神病理的轨迹。在过去的10年里，我们进行了这样一项研究，在罗马尼亚布加勒斯特的机构中，自出生以来被遗弃并被抚养的婴儿被随机分配，要么从机构中移出并被安置在家庭/寄养干预中，要么像往常一样留在机构中照顾。我们对这些儿童进行了8年的跟踪，到目前为止，54个月大的数据表明：a)早期的机构收容导致了脑电活动的紊乱，认知和社会情感行为的严重缺陷和延迟，以及精神疾病和损伤的发生率大大增加；b)我们的干预在促进儿童发展方面广泛有效，但是c)对于神经活动，语言，那里的认知和社会情感功能似乎是调节恢复的敏感期。在目前的提案中，我们将扩展这些分析，目的是预测两组儿童的心理健康结果：一组最初被分配到我们的寄养干预[FCG]，另一组最初被随机分配到机构中（照旧组[CAUG]），当他们12岁时，我们将把他们的功能与正常发育的年龄匹配的罗马尼亚儿童（从未被收容组[NIG]）进行比较。使用脑（EEG/ERP）和行为测量，我们建议：1)在12岁时，使用意向治疗设计重新检查早期机构对心理健康结果的长期影响，以及我们的干预在改善心理健康结果负担方面的效果；2)检查制度化的剂量（在机构中度过的时间百分比）如何影响长期结果；3)检查从早期机构康复的敏感期。

DESCRIPTION (provided by applicant): Sensitive periods are defined as a time in development during which the brain is particularly responsive to experiences in the form of patterns of activity (Daw, 1997).This time point may be termed a "critical" period if the presence or absence of an experience results in irreversible change (Newport, Hindle, & Jackson, 2001; Trachtenberg & Stryker, 2001). Those factors that allow a circuit underlying development to be plastic - or render it unchangeable - are becoming increasingly well understood in a small number of domains (i.e., visual and perceptual development). However, there is a paucity of data on sensitive periods for normative social and emotional development in human infants and children and little is known about the effects of aberrant experiences during early development on the emergence of psychopathology. The case of infants abandoned since birth into institutions provides an opportunity to examine the effects of severe psychosocial deprivation and sensitive periods in typical neural, social-emotional and cognitive development, as well as in trajectories that lead to psychopathology. Over the past 10 years we have conducted just such a study in which infants, abandoned since birth and raised in institutions in Bucharest, Romania, were randomly assigned either to be removed from the institution and placed into a family/foster care intervention or to be left in the institutions to care as usual. These children have been followed through 8 years of age and thus far, the data through 54 months of age indicate that a) early institutionalization leads to perturbations in brain electrical activity, profound deficits and delays in cognitive and socio- emotional behaviors, and a greatly elevated incidence of psychiatric disorders and impairment, b) our intervention was broadly effective in enhancing children's development, but c) for specific domains of neural activity, language, cognition and social-emotional functioning there appear to be sensitive periods regulating recovery. In the current proposal, we will extend these analyses with the aim to predict mental health outcomes in two groups of children: those originally assigned to our Foster Care intervention [FCG] and those originally randomized to remain in the institution (Care as Usual Group [CAUG] when they are 12 years of age, and we will compare their functioning to typically developing age-matched Romanian children (Never Institutionalized Group [NIG]). Using both brain (EEG/ERP) and behavioral measures, we propose to 1) reexamine, at age 12, the long term impact of early institutionalization on mental health outcomes and the efficacy of our intervention in ameliorating the burden of mental health outcomes using an intent-to-treat design; 2) examine how the dose of institutionalization (percent time spent in an institution) influences long term outcomes; and 3) examine sensitive periods in recovery from early institutionalization. PUBLIC HEALTH RELEVANCE: There are currently more than 70 million orphaned or abandoned children throughout the world. A common societal response to caring for such children is to house them in institutions. Children with histories of early institutionalization are at risk for developing a variety of mental health problems that have their origin in abnormal social behavior. The current application will examine the long term effects of early institutionalization on mental health outcomes in two groups of children with a history of institutionalization, as well as explore sensitive periods in recovery from institutionalization.